TY - JOUR
T1 - Health status and cognitive function for risk stratification in chronic coronary and peripheral artery disease
AU - Smolderen, Kim G.
AU - Mena-Hurtado, Carlos
AU - Eikelboom, John W.
AU - Bosch, Jackie
AU - Xie, Feng
AU - Ramasundarahettige, Chinthanie
AU - Bhatt, Deepak L.
AU - Anand, Sonia S.
N1 - Publisher Copyright:
© The Author(s) 2022.
PY - 2023/5/1
Y1 - 2023/5/1
N2 - Background and aims It is unclear whether health status and cognitive function assessments can augment traditional coronary artery disease (CAD) and peripheral artery disease (PAD) biomedical risk prediction frameworks. We examined the association between health status and cognitive function and subsequent adverse cardiovascular and limb events in CAD and PAD. Methods and results Stable CAD and PAD patients from the international, multi-centre COMPASS trial completed the visual analogue scale (VAS) of the EQ-5D-3L to assess overall health status, and the Digit Symbol Substitution test (DSST) to assess cognitive function. Main outcomes were incident development of major adverse cardiovascular events, and the combined endpoint major adverse cardiovascular or limb events. The EQ VAS (per 10 unit increase) and DSST (per 5 unit increase) were added to fully adjusted (medications, demographics, cardiovascular history and risk factors) hierarchical Cox regression models. A total of 23 433 patients were in the CAD cohort and 6899 in the PAD cohort. Among both the CAD and PAD groups, higher scores on the EQ VAS (CAD: HR = 0.89, 95%CI 0.88–0.89; PAD HR = 0.89, 95%CI 0.88–0.89) and DSST (CAD HR = 0.95, 95%CI 0.94–0.95) (PAD HR = 0.95, 95%CI 0.94–0.95) were associated with a lower risk of a major adverse cardiovascular or limb events. Population attributable risks associated with the lower two quartiles vs. upper quartiles for the EQ-5D and DSST scores were 7% and 16%, respectively in the CAD cohort; and for PAD, at 14% and 18%, respectively. Conclusions Adding health status and cognitive functioning information to biomedical evaluations can augment cardiovascular risk-stratification in CAD and PAD.
AB - Background and aims It is unclear whether health status and cognitive function assessments can augment traditional coronary artery disease (CAD) and peripheral artery disease (PAD) biomedical risk prediction frameworks. We examined the association between health status and cognitive function and subsequent adverse cardiovascular and limb events in CAD and PAD. Methods and results Stable CAD and PAD patients from the international, multi-centre COMPASS trial completed the visual analogue scale (VAS) of the EQ-5D-3L to assess overall health status, and the Digit Symbol Substitution test (DSST) to assess cognitive function. Main outcomes were incident development of major adverse cardiovascular events, and the combined endpoint major adverse cardiovascular or limb events. The EQ VAS (per 10 unit increase) and DSST (per 5 unit increase) were added to fully adjusted (medications, demographics, cardiovascular history and risk factors) hierarchical Cox regression models. A total of 23 433 patients were in the CAD cohort and 6899 in the PAD cohort. Among both the CAD and PAD groups, higher scores on the EQ VAS (CAD: HR = 0.89, 95%CI 0.88–0.89; PAD HR = 0.89, 95%CI 0.88–0.89) and DSST (CAD HR = 0.95, 95%CI 0.94–0.95) (PAD HR = 0.95, 95%CI 0.94–0.95) were associated with a lower risk of a major adverse cardiovascular or limb events. Population attributable risks associated with the lower two quartiles vs. upper quartiles for the EQ-5D and DSST scores were 7% and 16%, respectively in the CAD cohort; and for PAD, at 14% and 18%, respectively. Conclusions Adding health status and cognitive functioning information to biomedical evaluations can augment cardiovascular risk-stratification in CAD and PAD.
KW - Cardiovascular outcomes
KW - Cognitive functioning
KW - Health status
KW - Risk stratification
UR - http://www.scopus.com/inward/record.url?scp=85177062440&partnerID=8YFLogxK
U2 - 10.1093/eurjpc/zwac282
DO - 10.1093/eurjpc/zwac282
M3 - Article
C2 - 36444513
AN - SCOPUS:85177062440
SN - 2047-4873
VL - 30
SP - 535
EP - 545
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
IS - 7
ER -